"I wa baba" (Translation: I want my bottle.)
"Wa go momma?" (Translation: Where are you going, Momma?)
It's not a foreign language; it's baby talk, and even if you can't understand the words, it sounds adorable coming out of the mouths of babies.
But what if your 3-year-old is still talking that way? Then it could be a sign of a speech disorder, a potentially serious problem that requires professional diagnosis and therapy. Without such treatment, speech difficulties can cause significant problems for the growing child and may even persist into adulthood.
Unfortunately, most parents are slow to seek professional help for their children with speech disorders. Sometimes, the delay occurs because close family members, especially siblings, are able to decipher what the youngster is saying, even though it is largely incomprehensible to people outside the family. Professional diagnosis and treatment for speech problems are commonly delayed also because of the common belief that children will "grow out of it." This is not true, and some children pay a high price for the delay.
One bright 3-year-old we know became so frustrated and angry by constant requests to repeat herself, she stopped talking to anyone but her closest family members. When asked her age, she used three fingers in lieu of a verbal response; when questioned about anything more complicated, she would blush and hide behind the closest parent. Even at preschool, her inability to articulate words kept her from participating in classroom discussions, and she usually played alone.
Her parents, who are both physicians, did not recognize her serious speech disorder. As a result, they did not seek help from a speech therapist until just before her fourth birthday.
Before therapy can begin, the specific nature and cause of the problem must be defined. A child with an abnormally small vocabulary has a language problem and requires different treatment from a child with a speech disorder, in which case the vocabulary is normal but the child cannot articulate the words in an understandable manner. (The term "language" refers to the sounds, symbols and rules that people share for exchanging messages; speech is simply one way of expressing language, which can also be expressed through writing and signing, for example.)
Communication problems in children have many different causes. Learning disabilities, for example, can prevent a child from acquiring a normal vocabulary and developing appropriate language skills, while a lisp or other speech impediment can impair a child's ability to speak clearly.
A child with a hearing impairment can develop speech and language problems. The child who cannot hear much of what is being said will not learn as many words; the child who cannot hear the difference between "t" sounds and "sh" sounds will confuse these sounds when it comes time to start speaking.
Another important--and preventable--cause of communication problems is lack of adequate exposure to language and speech. Children learn language and speech by example, so it is important for parents to surround their children with examples, especially during the first three years of life.
Most children recognize the basic sounds of their native language by 6 months of age. Even with a very young infant, parents should constantly describe what is going on around the child, pointing to and naming familiar objects. Children will eventually connect the activities and objects with the words they are hearing. As a child begins to make sounds and words, parents should focus full attention on the child and encourage more "conversation." Reading aloud to a child of any age is an excellent way to promote healthy speech.
Hearing tests are also an important way to detect potential speech and language disorders. The American Academy of Pediatrics now recommends that all newborns have their hearing tested before being discharged from the hospital. Parents should also be on the alert for signs of hearing difficulty; for example, if the child does not respond to soft sounds or frequently asks people to repeat what they said. Seek out additional testing if necessary.
Parents play a critical role in the detection of speech and language problems. (Doctors may miss the diagnosis because they have such limited exposure to the child and because it's not abnormal for a child to "clam up" at the doctor's office.)
Parents should be on the lookout for the "normal" developmental milestones: Is the child babbling by 11 months of age? Is she putting two words together by age 2? Do people understand what she is saying by age 4? If a child fails to reach these milestones (see box), parents should talk to the child's doctor about the need for an evaluation by a specialist.
Early treatment of speech and language difficulties can make a big difference in a child's life. The girl we mentioned at the beginning of this column underwent eight months of weekly visits to a speech therapist and daily practice sessions with her parents.
Now she is 4 years old, and her speech is clear and comprehensible; she is starting to spell and read; and she has lots of friends at school. To the enormous relief of her parents, on those rare occasions when she still cannot be understood, she no longer gets frustrated and angry.
Dr. Jonathan Fielding is the director of public health and the health officer for the Los Angeles County Department of Health Services. Dr. Valerie Ulene is a board-certified specialist in preventive medicine practicing in Los Angeles. Send questions to email@example.com.
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